TRMA syndrome with a severe phenotype, cerebral infarction, and novel compound heterozygous SLC19A2 mutation: a case report

BMC Pediatr. 2019 Jul 11;19(1):233. doi: 10.1186/s12887-019-1608-2.

Abstract

Background: Thiamine-responsive megaloblastic anemia (TRMA) is a rare autosomal recessive inherited disease characterized by the clinical triad of megaloblastic anemia, sensorineural deafness, and diabetes mellitus. To date, only 100 cases of TRMA have been reported in the world.

Case presentation: Here, we describe a six-year-old boy with diabetes mellitus, anemia, and deafness. Additionally, he presented with thrombocytopenia, leukopenia, horizontal nystagmus, hepatomegaly, short stature, ventricular premature beat (VPB), and cerebral infarction. DNA sequencing revealed a novel compound heterozygous mutation in the SLC19A2 gene: (1) a duplication c.405dupA, p.Ala136Serfs*3 (heterozygous) and (2) a nucleotide deletion c.903delG p.Trp301Cysfs*13 (heterozygous). The patient was diagnosed with a typical TRMA.

Conclusion: Novel mutations in the SLC19A2 gene have been identified, expanding the mutation spectrum of the SLC19A2 gene. For the first time, VPB and cerebral infarction have been identified in patients with TRMA syndrome, providing a new understanding of the phenotype.

Keywords: Deafness; Diabetes; Novel mutation; SLC19A2 gene; Thiamine-responsive megaloblastic anemia.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anemia, Megaloblastic / drug therapy
  • Anemia, Megaloblastic / genetics*
  • Anemia, Megaloblastic / pathology
  • Arrhythmias, Cardiac / etiology
  • Atrophy
  • Brain / pathology
  • Cerebral Infarction / etiology*
  • Child
  • DNA Mutational Analysis
  • Diabetes Mellitus / drug therapy
  • Diabetes Mellitus / genetics*
  • Diabetes Mellitus / pathology
  • Diabetes Mellitus, Type 1 / etiology
  • Dwarfism / etiology
  • Female
  • Hearing Loss, Bilateral / etiology
  • Hearing Loss, Sensorineural / drug therapy
  • Hearing Loss, Sensorineural / genetics*
  • Hearing Loss, Sensorineural / pathology
  • Heterozygote
  • High-Throughput Nucleotide Sequencing
  • Humans
  • Male
  • Membrane Transport Proteins / genetics*
  • Phenotype
  • Thiamine / therapeutic use
  • Thiamine Deficiency / congenital*
  • Thiamine Deficiency / drug therapy
  • Thiamine Deficiency / genetics
  • Thiamine Deficiency / pathology
  • Ventricular Premature Complexes / etiology

Substances

  • Membrane Transport Proteins
  • SLC19A2 protein, human
  • Thiamine

Supplementary concepts

  • Thiamine responsive megaloblastic anemia syndrome